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Diagnostic Accuracy of the Synovial Fluid α-Defensin Lateral Flow Test in Periprosthetic Joint Infection: A
Yu-Qing Zeng1,2, Shu Deng3, Xing-Yang Zhu1
1The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
Objectives:
There is a controversy on the diagnostic reliability and accuracy of synovial fluid α-defensin in periprosthetic joint infection (PJI). We performed this meta-analysis to evaluate the diagnostic accuracy of the α-defensin lateral flow test in PJI.
Methods:
PubMed, Embase, and the Cochrane library were systematically searched, and articles (up to January 2020) on the diagnosis of hip and knee PJIs using the α-defensin Synovasure lateral flow test were included. The diagnostic accuracy of the α-defensin lateral flow test in PJI was evaluated using meta-analysis. The pooled sensitivity, specificity, accuracy, positive and negative likelihood ratio, diagnostic odds ratio, and post-test probabilities were calculated.
Results:
Seventeen studies including 1443 cases were included. Meta-analysis showed the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and a diagnostic odds ratio was 0.83 (95% CI 0.77, 0.88), 0.95 (95% CI 0.93, 0.97), 16.86 (95% CI 11.67, 24.37), 0.17 (95% CI 0.13, 0.24) and 85.30 (95% CI 47.76, 152.35), respectively. The area under the hierarchical summary receiver operating characteristic curve was 0.97 (95% CI 0.95, 0.98). Subgroup analysis also confirmed the high efficiency of α-defensin Synovasure lateral flow test in diagnosing PJIs, irrespective of ethnicity. Fagan's nomogram analysis there was a high positive post-test probability of 94% and a low negative post-test probability of 15%.
Conclusions:
We indicated that the α-defensin lateral flow test had a high accuracy for diagnosing PJI. Large-scale studies are needed to validate its significance in PJI diagnosis.
Insights
The synovial fluid alpha-defensin lateral flow test accurately diagnoses periprosthetic joint infection (PJI). This meta-analysis confirms its high sensitivity and specificity for PJI detection.
Area of Science:
- Orthopedics
- Infectious Diseases
- Diagnostic Medicine
Background:
- Periprosthetic joint infection (PJI) poses a significant challenge in orthopedic surgery.
- The diagnostic accuracy of synovial fluid alpha-defensin tests for PJI remains debated.
- Reliable diagnostic tools are crucial for timely and effective PJI management.
Purpose of the Study:
- To evaluate the diagnostic accuracy of the alpha-defensin lateral flow test for periprosthetic joint infection (PJI).
- To synthesize existing evidence through a comprehensive meta-analysis.
Main Methods:
- Systematic literature search of PubMed, Embase, and Cochrane Library databases (up to January 2020).
- Inclusion of studies evaluating the alpha-defensin Synovasure lateral flow test for hip and knee PJI diagnosis.
- Meta-analysis to calculate pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratio.
Main Results:
- Included 17 studies with 1443 cases.
- Pooled sensitivity was 0.83 and specificity was 0.95.
- High diagnostic accuracy indicated by a diagnostic odds ratio of 85.30 and an AUC of 0.97.
- Positive post-test probability reached 94%, with a negative post-test probability of 15%.
Conclusions:
- The alpha-defensin lateral flow test demonstrates high accuracy in diagnosing PJI.
- Further large-scale studies are recommended to confirm its clinical significance.
- The test shows consistent efficiency across different ethnicities.
